| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,972 |
813 |
$105K |
| D2394 |
|
1,047 |
745 |
$71K |
| D2335 |
|
800 |
458 |
$68K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,092 |
693 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,241 |
744 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
2,677 |
2,387 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,086 |
588 |
$50K |
| D1110 |
Prophylaxis - adult |
1,526 |
1,502 |
$48K |
| D0330 |
Panoramic radiographic image |
920 |
885 |
$37K |
| D2332 |
|
519 |
338 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,449 |
1,426 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,060 |
1,045 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,169 |
1,153 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
3,895 |
3,311 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,389 |
1,820 |
$16K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
28 |
25 |
$9K |
| D1120 |
Prophylaxis - child |
446 |
439 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
521 |
513 |
$7K |
| D7220 |
|
57 |
40 |
$5K |
| D0272 |
Bitewings - two radiographic images |
206 |
201 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
31 |
31 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
13 |
$2K |
| D0180 |
|
13 |
13 |
$342.55 |
| D0470 |
|
12 |
12 |
$176.16 |